背景:本系统综述的目的是分析非侵入性脑刺激(NBS)治疗中风后中枢疼痛(CPSP)的疗效。
方法:我们纳入了随机对照试验,测试了经颅磁刺激(TMS)或经颅直流电刺激与安慰剂或其他常规治疗对CPSP患者的疗效。英文文章,葡萄牙语,西班牙语,意大利语,和法国人都包括在内。2022年6月1日,两位作者独立进行了书目搜索,使用数据库MEDLINE(PubMed),Embase(Elsevier),Cochrane中央对照试验登记册(中央),Scopus,和WebofScience核心合集。使用第二版Cochrane偏差风险(RoB2)工具评估偏差风险,并通过建议评估等级评估评估证据的确定性。发展和评价。
结果:删除重复项后,共识别出2,674条记录,其中包括5项符合条件的研究,共119名患者。所有五项研究都评估了重复性TMS,其中四个刺激了初级运动皮层(M1),一个刺激了运动前/背外侧前额叶皮层。只有前者报告短期内疼痛显着减轻,而后者由于持续缺乏镇痛作用而中断。
结论:M1区的NBS似乎可有效减轻短期疼痛;然而,更多高质量的同质研究,通过长期随访,需要确定这种治疗在CSPS中的疗效。
BACKGROUND: The aim of this systematic review is to analyze the efficacy of noninvasive brain stimulation (NBS) in the treatment of central post-stroke pain (CPSP).
METHODS: We included randomized controlled trials testing the efficacy of transcranial magnetic stimulation (TMS) or transcranial direct current stimulation versus placebo or other usual therapy in patients with CPSP. Articles in English, Portuguese, Spanish, Italian, and French were included. A bibliographic search was independently conducted on June 1, 2022, by two authors, using the databases MEDLINE (PubMed), Embase (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science Core Collection. The risk of bias was assessed using the second version of the Cochrane risk of bias (RoB 2) tool and the certainty of the evidence was evaluated through Grading of Recommendations Assessment, Development and Evaluation.
RESULTS: A total of 2,674 records were identified after removing duplicates, of which 5 eligible studies were included, involving a total of 119 patients. All five studies evaluated repetitive TMS, four of which stimulated the primary motor cortex (M1) and one stimulated the premotor/dorsolateral prefrontal cortex. Only the former one reported a significant pain reduction in the short term, while the latter one was interrupted due to a consistent lack of analgesic effect.
CONCLUSIONS: NBS in the M1 area seems to be effective in reducing short-term pain; however, more high-quality homogeneous studies, with long-term follow-up, are required to determine the efficacy of this treatment in CSPS.